Value of standard personality assessments in informing clinical decision-making in a medium secure unit

Abstract

Background: Assessing those with personality disorder for treatment in secure settings is known to be unsatisfactory. Aim: To examine the utility of a standardised assessment of offenders with personality disorder referred for treatment in secure care in a naturalistic study. Method: A consecutive series of 89 men were assessed with a battery of four recommended instruments measuring personality and risk. Decisions on whether or not to admit were based on a multidisciplinary discussion informed by these assessments. Results: Of the 89 comprehensively assessed referrals, 60 (67%) were offered admission. High scores on the Psychopathy Checklist-Revised (especially on Factor I) was the only measure that was associated with rejection. Of 44 patients discharged, 29 (66%) failed to complete treatment; none of the pre-admission assessments distinguished 'completers' from 'non-completers'. Although skills were acquired on the unit, follow-up of 24 men in the community showed that this had only a marginal effect on re-offending rate (58%). Conclusions: Current recommended assessment methods appear unsatisfactory in identifying those who either (a) complete treatment or (b) benefit from treatment. Our results throw doubt on their value.